Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus: A multicenter retrospective study with cost-benefit analysis in Turkey.

Ventriculoperitoneal shunt systems that are used in the treatment of normal pressure hydrocephalus are often associated with drainage problems. Adjustable shunt systems can prevent or treat these problems, but they may be expensive. The aim of our study is to compare the complications and total cost of several shunt systems.Patients with normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between 2011 and 2016 were included in the study. The study involves patient consent and the informed consent was given. Complications and the average cost per person were compared between patients with adjustable and nonadjustable shunts. Shunt prices, surgical complications, and revision costs were taken into account to calculate the average cost.Of the 110 patients who were evaluated, 80 had a nonadjustable shunt and 30 had an adjustable shunt. In the group with adjustable shunts, the rates of subdural effusion and hematoma were 19.73% and 3.29%, respectively. In the group with nonadjustable shunts, these rates were 22.75% and 13.75%, respectively. One patient in the adjustable group underwent surgery for subdural hematoma, while 8 patients in the nonadjustable group underwent the same surgery. Ten patients required surgical intervention for subdural effusion and existing shunt systems in these patients were replaced by an adjustable shunt system. When these additional costs were factored into the analysis, the difference in cost between the shunt systems was reduced from 600 United States dollars (USD) to 111 USD.When the complications and additional costs that arise during surgical treatment of normal pressure hydrocephalus were considered, the price difference between adjustable and nonadjustable shunt systems was estimated to be much lower.

Protective effects of minocycline on experimental spinal cord injury in rats.

BACKGROUND: The effects of minocycline on neuronal injury after spinal cord injury (SCI) are limited and controversial. Therefore we aimed to investigate the protective effects of minocycline on tissue and on serum concentrations of malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-Px) activity, tissue total antioxidant and oxidant status (TAS and TOS, respectively), and AST and LDH levels in rats with SCI. METHODS: This study was performed on 7-8 weeks 38 male Wistar albino rats. The animals were randomly divided into five groups: group 1, Sham (n=8); group 2, SCI (spinal cord injury)/control (n=8); group 3, SCI+minocycline3 (n=7); group 4, SCI+minocycline30 (n=8) and group 5 SCI+minocycline90 (n=7). Blood and tissue samples were analysed for MDA, SOD, GSH-Px, TAS, TOS, AST and LDH levels. RESULTS: The MDA levels were significantly higher in SCI group compared to sham group (p<0.001), and MDA levels were also significantly higher in SCI group compared to SCI+M3, SCI+M30, SCI+M90 (p<0.05). SOD levels were significantly higher in SCI+M30 when compared to SCI and SCI+M3 groups (p<0.05). GSH-Px levels decreased significantly in SCI and SCI+M3 groups compared to sham (p<0.05). SCI+M3 group showed significantly decreased levels of TAS and TOS compared to SCI group (p<0.05). TAS and TOS levels significantly increased in SCI+M90 group compared to SCI+M3 and SCI+M30 groups (p<0.05). CONCLUSIONS: The present study demonstrates the dose-dependent antioxidant activity of minocycline against spinal cord injury in rats. Minocycline administration increased antioxidant enzyme levels and improved total antioxidant status.

Evaluation of Lymphocyte Subgroups in Children With Down Syndrome.

In this study, lymphocyte subgroups including blood CD3, CD4, CD8, CD4/CD8, CD19, and CD16.56 values were analyzed in children with Down syndrome (DS). The study includes 85 children with DS, followed at Department of Pediatrics, Faculty of Medicine, Yüzüncü Yil University and 64 healthy age-matched control participants. Blood CD3, CD4, CD8, CD4/CD8, CD19, and CD16.56 values were examined in both the groups. Significantly decreased blood CD3, CD4, and CD19 values were found in the study group (P < .05) when compared with the control group. In conclusion, we would like to emphasize that blood CD3, CD4, and CD19 levels were found to be decreased in children with DS. Based on these finding, we think that these decreased lymphocyte subgroups might be responsible for increased susceptibility to infections in children with DS.

Protective effects of minocycline against short-term ischemia-reperfusion injury in rat brain.

The aim of this study was to assess the effects of minocycline on cerebral ischemia-reperfusion (I/R) injury in rats. The study was carried out on 24 male Wistar albino rats, weighing 200-250 g, which were divided into three groups: (i) control (n = 8), (ii) I/R (n = 8) and (iii) I/R + minocycline (n = 8). Minocycline was administrated at a dose of 90 mg/kg p.o. to the I/R group 48, 24 and 1 h before ischemia. Following bilateral exposure of the common carotid arteries by anterior cervical dissection and separation of the vagus nerve, I/R injury was performed by occlusion. Following reperfusion, malondialdehyde (MDA), superoxide dismutase, glutathione peroxidase and catalase levels in the blood and brain tissue, and creatine kinase (CK), CK-BB, lactate dehydrogenase (LDH), neuron-specific enolase (NSE) and protein S100ß levels in the blood were measured and the histopathological changes were monitored. Regarding histopathological evaluation, symptoms of degeneration were significantly improved in the I/R + minocycline group compared to the I/R-only group. Statistical analysis of the biochemical parameters revealed significant differences in MDA (p < 0.001), nitric oxide (p < 0.05), CK (p < 0.05) and CK-MB (p < 0.05) levels between the I/R + minocycline group and the I/R group. According to the literature, the effect of minocycline is firstly assessed by LDH, CK-MB, NSE and S-100ß analysis in addition to antioxidant status and histopathological analysis.

The Dowling-Orlando technique in a giant primary cerebral hydatid cyst: a case report.

Hydatid cyst disease is a parasitic illness that is rarely located in the brain. We present a case of a 26-year-old female who complained of headache, nausea, and vomiting. The diagnosis was intracranial hydatid cyst disease and was confirmed with radiological and serological tests. Neurological examination revealed papilloedema and left-sided pyramidal signs. She was operated on using the Dowling-Orlando technique. The cyst was removed without rupture, and therapy was completed with albendazole for a period of four weeks. In this article, we discuss the application of the Dowling-Orlando technique, microsurgery, the Valsalva manoeuvre and the positioning of the patient such that gravity could facilitate surgical removal of a giant cerebral hydatid cyst.

Prognostic factors in patients with occipital encephalocele.

BACKGROUND: An encephalocele is a herniation of the brain and the meninges through a skull defect protruding towards the exterior. The condition is not rare when compared to spinal dysraphisms, but the worldwide incidence is not precisely known. The cases involving occipital encephaloceles which we have diagnosed in our clinic and the surgical approaches for this rare condition are presented herein. METHODS: Thirty patients who were diagnosed with occipital encephaloceles and referred to our Neurosurgery Clinic at the Yuzuncu Yil University, Faculty of Medicine Research Hospital between 2000 and 2009 were enrolled in this study. The age of the patient, size of the sac, pathologies that accompanied the condition, and treatments applied were assessed. RESULTS: In the present study, 30 patients (22 girls and 8 boys), whose ages varied between newborn and 14 months, were evaluated. The encephalocele sac was located in the occipital region in 27 patients (90%) and in the occipitocervical region in 3 patients (3%). Nine (30%) of the 30 patients died; 2 in the preoperative period, 2 in the postoperative early period (0-7 days) and 5 in the late postoperative period (first week to 3 months). With the exception of the 2 patients who died preoperatively, surgery was performed on all of the patients. The mortality rate in our study was 29%. CONCLUSIONS: Our study demonstrated that factors which determine the prognosis of patients diagnosed with occipital encephaloceles include the size of the sac, the contents of the neural tissue, hydrocephaly, infections, and pathologies that accompany the condition. An occipital encephalocele is a congenital neurologic condition with an extremely high morbidity and mortality in spite of the treatments rendered pre- and postoperatively.

Electrophysiological and clinical assessment of response to surgery in carpal tunnel.

The objective of this study was to assess the clinical and electrophysiological changes before and after surgery in 44 patients who underwent surgical intervention due to the diagnosis of carpal tunnel syndrome (CTS). Patients who were diagnosed with a slight, moderate, and severe idiopathic CTS were assessed clinically and by electrophysiological tests before (mean 2-4 weeks) and after surgery (at sixth month). Improvement in clinical parameters was achieved more significantly than electrophysiological recovery.

Cavernous hemangioma presenting as a giant cervical mass: a case report.

Intramuscular hemangiomas of the head and neck are rare congenital vascular tumors and are sparsely reported. Hemangiomas account for approximately 7% of benign tumors and usually present as a mass that suddenly enlarges. Hemangiomas are mostly seen on the trunk and extremities, but can also appear on the head and neck region. A10-year-old boy was referred to our clinic for puffiness and swelling on the right side of his neck. Neurological examination was normal, but we observed an advanced degree of restriction in neck movement. An MRI study showed a soft tissue mass 9 x 8 x 5 in size. The mass was totally extracted by surgical intervention and pathological analysis revealed that it was a cavernous hemangioma. The patient's neck movement returned to normal after surgery. No relapse occurred during 1-year follow-up.

Cervical spinal dysraphism.

OBJECTIVE: Cervical spinal dysraphism is a rare congenital spinal pathology. The results obtained from our series are compared with the results obtained from other series of studies in the literature. METHODS: Seven patients with cervical myelomeningocele and meningocele who underwent surgery between January 1996 and March 2009 at the YYU Faculty of Medicine in the Department of Neurosurgery were retrospectively studied. RESULTS: The referral ages of the patients (6 females and 1 male) varied between 4 days and 4 months (median 1 month). A stalk lesion covered with a dysplastic skin formed as a sac and located at the cervical midline was demonstrated in all of the patients. Cervical myelomeningocele was present in 4 patients, while cervical meningocele was present in 3 patients; however, Chiari type II malformation and hydrocephaly were present in 3 patients with myelomeningoceles. Diastematomyelia and a filum terminal lipoma were present in 1 of the patients. CONCLUSION: In this series, in contrast to the literature, we noted that the number of girls with spinal dysraphism with a cervical myelomeningocele and meningocele was greater than the number of boys. Chiari type II malformation, hydrocephaly and motor weakness in patients with cervical spinal dysraphism are less frequent when compared to patients with caudal spinal dysraphism. The structure of the sac is also more durable and, accordingly, a cerebrospinal fluid leakage is uncommon.

Protective effects of tadalafil on experimental spinal cord injury in rats.

Tadalafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). Nitric oxide (NO) functions as a retrograde neurotransmitter in the spinal cord, and postsynaptic structures respond to NO by producing cGMP. The concentrations of cGMP in the spinal cord are controlled by the actions of PDE. The aim of the study was to evaluate and compare the effects of the use of both methylprednisolone and tadalafil on serum and tissue concentrations of NO, malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, and tissue glutathione peroxidase (GSH-Px) activity in rats with spinal cord injury (SCI). SCI was induced in Wistar albino rats by dropping a 10 g rod from a 5.0 cm height at T8-10. The 28 rats were randomly divided into four equal groups: tadalafil, methylprednisolone, non-treatment and sham groups. Rats were neurologically tested at 24 hours after trauma. At the end of the experiment, blood samples were collected and spinal cord tissue samples were harvested for biochemical evaluation. The tissue level of NO was increased in the tadalafil group compared with the non-treatment and methylprednisolone groups (p<0.05). The tissue levels of SOD and GSH-Px did not differ between the groups. Serum levels of NO were higher in the tadalafil group than in the non-treatment group (p<0.05). The increase in serum SOD levels was greater in the tadalafil group than the methylprednisolone group. Serum MDA levels in the tadalafil and methylprednisolone groups tended to be lower than in the non-treatment group (p>0.05). Tissue MDA levels in the tadalafil and methylprednisolone groups tended to be lower than in the non-treatment group and sham groups (p>0.05). Although there was no difference in neurological outcome scores between the tadalafil, methylprednisolone and non-treatment groups (p>0.05), the animals in the tadalafil and methylprednisolone groups tended to have better scores than the non-treatment group. Thus, tadalafil appears to be beneficial in reducing the effects of injury to the spinal cord by increasing tissue levels of NO and serum activity of SOD.

Fibre-optic bronchoscopy-assisted percutaneous dilatational tracheostomy by guidewire dilating forceps in intensive care unit patients.

OBJECTIVE: The purpose of this study was to prospectively analyze intensive care unit patients with fibre-optic bronchoscopy-assisted percutaneous dilatational tracheostomy by guidewire dilating forceps (GWDF; Griggs percutaneous tracheostomy). DESIGN: Prospective study. SETTING: A tertiary care centre. MATERIALS AND METHODS: Fifty-two critically ill patients (32 men and 20 women), aged 16 to 84 years (mean +/- SD 42 +/- 1.6 years) who required endotracheal intubation for longer than 15 days were consecutively selected to undergo tracheostomy by the GWDF technique. The diagnoses of the patients and intraoperative and postoperative complications were recorded. RESULTS: The patients were mechanically ventilated for an average of 14.8 +/- 1.2 days. The duration of the GWDF technique was 4.9 +/- 1.7/min. Intraoperative complications occurred in 10 (19.2%) patients: hemorrhage in 3 cases, puncture of the tracheal tube in 2 cases, difficult cannulation in 2 cases, difficult dilatation in 1 case, false passage in 1 case, and inadvertent extubation in 1 case. Postoperative complications occurred in three (5.7%) patients, stomal cellulitis in one case, subcutaneous emphysema in one case, and difficult recannulation in the remaining case. CONCLUSIONS: Fibre-optic bronchoscopy-assisted percutaneous dilatational tracheostomy by GWDF is a simple and fast technique for inserting a tracheal cannula.

[Treatment of olfactory neuroblastoma via subfrontal and midfacial degloving approaches: a case report]. / Olfaktör nöroblastomun subfrontal kraniofasyal ve midfasyal degloving yaklasimlarla tedavisi: Olgu sunumu.

A 12-year-old girl presented with complaints of nasal obstruction and a right infraorbital swelling. A biopsy obtained from the right nasal passage revealed olfactory neuroblastoma. The tumor was completely excised via subfrontal craniofacial and midfacial degloving approaches. No recurrence was observed during a three-year follow-up.

Skin perforators of back region: anatomical study and clinical applications.

BACKGROUND: Despite widespread studies that have been commonly performed recently on skin perforators and perforator flaps of various regions of the body, investigations on the back region of the body are still insufficient. This study investigates the anatomical characteristics and clinical applications of perforating vessels in the back region. MATERIALS AND METHODS: The skin on the back region between the right and left, 7th to 11th thoracic vertebrae of 10 fresh cadavers were raised as flaps. Perforating vessels perfusing the skin with pedicle diameters of over 1 mm were included in the study. The anatomical localization, diameter, pedicle size, and the supplying vessels of these pedicles were determined. Utilizing this information, the defects of 8 patients with large meningomyeloceles included in the study were closed with prepared intercostal artery perforating flap. RESULTS: Perforators of the back region were seen to originate from the posterior intercostal vessels. There were a higher number of perforators on the right side of the body. The most commonly observed perforators were the 7th and 9th posterior intercostal perforators, and their diameters were larger. All flaps were viable following perforator flap closure for defects in 8 patients with large meningomyelocele included in the clinical study. No problems were encountered in the postoperative 3-month follow-up of cases. CONCLUSION: Owing to the low donor area morbidity and wide motion capabilities, the perforator flap is a new choice of flap for the back region. Perforator pedicle flaps supplied by the posterior intercostal vessels may be safely used in congenital tissue defects, such as meningomyelocele, tumors, and traumatic defects.

Protective effect of sildenafil (Viagra) in transient spinal cord ischemia.

Prospective study of the neuroprotective activity of sildenafil in a rat spinal ischemia model. The present study involved 21 male Sprague-Dawley rats. The animals were divided into 3 groups. Physiological serum was administered intraperitoneally to the 8 rats in the control group at the beginning of reperfusion for a period of 20 min after abdominal aortal occlusion. Sildenafil (Viagra) was administered as a single 10-mg/kg/day intraperitoneal dose to the 8 rats in the sildenafil group at the beginning of reperfusion after 20 min of abdominal aortal occlusion. No occlusion was performed and no agent was administered to the 5 rats in the sham group, but the abdominal aorta was reached by means of surgical intervention. Before the animals were sacrificed, several physiological and biochemical parameters were investigated, preoperative and postoperative motor functions were also assessed, and somatosensory evoked potential (SEP) monitoring and histopathological examinations were carried out. No differences were found between the physiological and biochemical parameters in each of the 3 groups. Neurological scoring performed after reperfusion demonstrated a significant improvement in the neurological results relative to those of the control group over 48 h in subjects that received sildenafil. These animals also showed better 24-hour SEP results, measured in terms of extended latency and decreased amplitude, than the control animals. A histopathological study showed reduced ischemic symptoms in rats that received sildenafil compared with those in the control group. However, no anomalies were observed in the sham group with respect to the histopathological and neurological findings. These results indicate that neurological damage due to spinal-cord ischemia-reperfusion injury can be reduced by sildenafil.

Investigation of neuroprotective effect of dexamethasone by using nitric oxide and leukocyte levels in experimental head trauma.

The objective of the present study was to determine the levels of nitric oxide (NO) and white blood cells (WBCs), which are assumed to play a role in secondary cerebral damage by increasing to pathological levels during cranial trauma, and to investigate the neuroprotective effect of dexamethasone on NO and WBC levels in experimental cranial trauma. For this purpose, adult Sprague-Dawley male rats were used. Blood NO and WBC levels were investigated in one group of non-trauma rats (control group, n = 10) after 6 h; in a group of rats with experimental post-cranial trauma (trauma group, n = 10) after 6 and 24 h; and in a third group of rats with experimental cranial trauma, intraperitoneally injected with 10 mg/kg dexamethasone after 1 and 12 h (trauma + dexamethasone group, n = 10), WBC and NO levels were measured after 6 and 24 h. Determination of NO levels was carried out by assaying serum nitrite and nitrate levels. The increases in post-trauma serum NO (nitrite and nitrate) and WBC levels were statistically significant for the trauma and trauma + dexamethasone groups compared to controls. There was no significant difference between serum NO and WBC levels in rats in the trauma + dexamethasone and those in the trauma group. The study demonstrated no significant inhibition of NO and WBC levels by dexamethasone, a drug used for its anti-edema and anti-inflammatory effects and its influence on membrane stabilization and in avoiding oscillation stress. In the present study, dexamethasone was found to be ineffective in decreasing NO and WBC levels to avoid secondary cerebral damage after cranial trauma.

Activity of mannitol and hypertonic saline therapy on the oxidant and antioxidant system during the acute term after traumatic brain injury in the rats.

In this study, our objective is to investigate the effects of mannitol and 7.5% hypertonic saline (HS) therapy on the levels of malondialdehyde (MDA), catalase and glutathione peroxidase (GSH-Px) in the early stages of experimental head traumas in rats. Rats included in the study were divided into four groups: Group I Control, Group II Trauma, Group III Mannitol, and Group IV 7.5% Hypertonic Saline. Rats in Group II were subject to head trauma only. Mannitol was injected intraperitoneally to rats in Group III after head trauma and 7.5% HS was injected intraperitoneally to rats in Group IV after head trauma. Rats were sacrificed 4 h after administration of mannitol or 7.5% HS, and the levels of MDA catalase and GSH-Px in brain tissues extracted from rats were determined. MDA levels in the trauma group were significantly increased compared with the control group (p<0.01), whereas there was a reduction in catalase and GSH-Px levels, although these differences were not significant. By contrast, in the mannitol group, MDA, catalase and GSH-Px levels were lower than the levels in the trauma group, and these reductions were statistically significant (p<0.05). The MDA, catalase and GSH-Px levels of the 7.5% HS group were lower than those of the trauma group; however, this reduction was not statistically significant. It was concluded that mannitol and 7.5% HS therapies that are used to reduce intracranial pressure and to increase the use of catalase, an antioxidant enzyme, and GSH-Px, are likely to reduce cellular damage by reducing the formation of MDA, the levels of which are known to be indicative of cellular level oxidant damage.

Plasma vitamin E and selenium levels in rats with head trauma.

BACKGROUND: Free radicals play an important role in brain damage induced by a head trauma. In this study, we examined the prevention of brain damage that occurs after oxidative stress in rats that had undergone an experimental head trauma and the determination of plasma levels of vitamin E and selenium, which are recognized as antioxidant agents. METHODS: In this study, adult male Sprague-Dawley rats were used. Rats were divided into 2 groups. In the first group (control group, n = 10), pretraumatic plasma selenium and vitamin E levels were investigated and rats were not traumatized. In the second group (trauma group, n = 10), posttraumatic plasma selenium and vitamin E levels were investigated at the 6th and 24th hours in traumatized rats. RESULTS: In the control group, the plasma selenium level was 107 +/- 8.113 microg/L, whereas vitamin E level was 1.310 +/- 0.048 mg/dL. In the trauma group, the plasma selenium level was 79.93 +/- 3.130 microg/L at the 6th hour and 74.74 +/- 2.947 microg/L at the 24th hour, whereas the vitamin E level was 1.211 +/- 0.056 mg/dL at the 6th hour and 1.136 +/- 0.044 mg/dL at the 24th hour. Normal plasma selenium and vitamin E levels were significantly reduced in the early period after trauma. CONCLUSION: Because of oxidative stress that occurs directly after a head trauma, vitamin E and selenium depletion occurs in the early period. This condition supports the idea that brain damage can be reduced if decreased antioxidants are replaced when a head trauma occurs. We believe that these findings will guide and assist in future studies to develop clinical management strategies to prevent brain damage induced by head trauma.

Two cases of subacute sclerosing panencephalitis associated with brainstem involvement.

The most commonly involved areas in subacute sclerosing panencephalitis (SSPE) are periventricular and subcortical white matter. The basal ganglia, cerebellum, spinal cord and corpus callosum are less commonly involved. Brainstem involvement is rare and usually accompanied by other intracranial lesions. In this article, we report two cases of SSPE associated with brainstem involvement. The first case a 9-year-old girl had the typical symptom of SSPE. Magnetic resonance imaging (MRI) of the brain revealed a focal lesion 2 x 2.5 cm a diameter in the pons. The second case was a 6-year-old girl. On admission, MRI of the brain was normal. During 6th month of follow-up, T2-weighted MRI showed a hyperintense lesion in the pons and pedincule of cerebellum. On account of these cases we would like to stress that brainstem involvement may be seen in patients with SSPE; therefore, these patients should be monitored for this disorder.

Controversies in chronic subdural hematoma: continuous drainage versus one-time drainage.

BACKGROUND: Various surgical methods are recommended for the therapy of chronic subdural hematoma (CSH). In this study, burr-hole continuous drainage (CD) and burr-hole one-time drainage (OTD) methods for the treatment of CSH are retrospectively compared. MATERIAL/METHODS: Fifty patients with CSH referred to this clinic between July 1995 and December 2003 were selected for treatment. Twenty-one patients were treated by the burr-hole OTD method and 29 patients received burr-hole CD therapy. The recurrence rates and the extension of the hematoma were evaluated with respect to the period of postoperative hospitalization to evaluate the most effective RESULTS: The postoperative hospitalization period was 7.9 days in the burr-hole continuous drainage group and 17 days in the burr-hole one-time drainage group. Recurrence developed in two cases (6.8%) in the CD group and in six cases (28.5%) in the OTD group. When the pre- and postoperative hematoma extension in the CD group were compared, a significant degree of decrease was observed on post-op day 1. Extension of the hematoma was found to be minimal in the days following the modification. The width of the hematoma in the OTD group was also reduced at post-op day 1; however, the degree of this decrease was not significant. CONCLUSIONS: Continuous drainage therapy for CSH is superior to the one-time drainage method due to the shorter time of post-op hospitalization and to the reduced rate of recurrence.